What does Hand Under Hand mean?”

It means your hand is under the student’s hand for certain activities. Do you usually pick up a child’s hand or wrist? Instead, slide your hand under theirs. Practice from various angles.

Why use Hand Under Hand (HUH)? Because, when used consistently, this strategy:

  • Allows the student access to the ways people use their hands. The student can experience hands in relation to one another, including direction of movement, amount of force, speed or tempo. (We take this for granted!)
  • Provides a person who is blind or has low vision with spatial awareness through tactile experience.
  • Encourages authentic involvement of the student in routine tasks that they cannot yet perform independently.
  • Stimulates curiosity about what’s around them & increases the desire to do things for themselves, reducing passivity and dependence. If the student’s hands are on top of the adult’s hands, the student makes the choice of moving with that person’s hands, thus requiring active learning on their part.
  • Prepares for tactile signing by teaching the student to learn to reach for communication.

You have not yet trained him to “observe” with his hands. Do that first.
Get a hand lotion program into his daily schedule.
Also start this part of his HUH program with something that is easier for you; one that is not a high skill level even if he is an older, able student. Cutting food and shoe tying are much too high skill and dexterity level for first time experiences.
Start with something that is also more highly motivating, either new or familiar for the student.
Or, start with something which he only needs to refine. Use an already successful task that he needs to be aware that there is a more mature, graceful or efficient way to do it. For the above example and setting, it might be his spoon or fork grasp, or napkin use.
When he has learned how to “watch” with his hands, and enjoyed or benefited from it, then reintroduce observation of cutting.

This sounds more like a learned, self-protective response rather than tactile defensiveness even if there is a history of tactile defensiveness.
Tell her, or proceed with the attitude of: “You are in charge. You just watch me. You don’t have to touch it. You are in control.”
Restore her hands on top of yours and proceed.
Honor your promise. Do not deliberately remove yours from under hers, do not prompt or cajole her to feel it herself.
When she is ready, she will decide to feel for herself. Curiosity will get the best of her and her hands will drift off of yours to explore. Trust the human internal drive and curiosity.

He probably does not behave this way for other activities that are less emotionally charged or have a high interest and curiosity for him.
Use a different task first. Earn his trust by respecting his interest and his internal drive.
The first stage is to get them used to putting their hands on someone else’s hands as a means of getting information. Use a fun, enjoyable activity first.

The student will clue you.
You will feel or see them begin to seek more information about what you are doing.
You will feel or see them anticipate what will happen next, e.g., slide toward the next button and button hole.
They sometimes actually start taking over and trying to do it themselves.
They will verbally or behaviorally tell you, “I can do it myself!”
Remember, if they show a readiness and the buttons and buttonholes, for example, are too difficult for them to learn on, you must “sensory enhance,” i.e. enlarge, the task. Adapt a vest or smock with big buttons and vertical buttonholes. See buttoning hand-out.

This student probably needs touch information. Perhaps you now have a way to make it acceptable, meet his needs and decrease other inappropriate touching.
If he can’t keep his hands on yours because his hands are drifting around exploring your body, ask him “Can I help you keep your hands on mine so you can learn” Someday you will be able to do this yourself.” (If the student cannot process spoken information, try the following…)
Use your thumbs to gently hold his thumbs.
Be sure that you are starting with an interesting, motivating task with no performance demands yet.
It is my expectation that this method offers the potential for such students to become more grounded in the physical world, and more competent. An annoying behavior such as inappropriate touching will no longer be needed.
Start with the Hand Lotion program.

Yes, when you are working with students who have not learned this method and who have not otherwise mastered spatial concepts, problem solving and hand skills, you may not be successful. You don’t have the time and the student has no foundation for using this method.
Have parents and other regular staff get the program started (with Hand Lotion program in his daily schedule) Once they establish this way of learning, your job will be easier.
Teach parents and other regular staff the other aspects of a Hand Under Hand program so that the student gets the daily practice. Then you can introduce new skills to the student and his family or educational staff more easily.
If a child has usable hearing, later on you may not even need Hand Under Hand because spatial language will be more meaningful and we will be more successful talking them through a task.
We all get caught up in getting the task done and we rush the students by telling them what to do or by picking up their hands (Hand Over Hand) to manipulate them through the task.
We rob students of neat learning experiences all the time. It will appear new to you because you are changing old habits, too.

Adapted from material by: Geraldine G. Larrington, MA,OTR/L, Arizona Schools for the Deaf & Blind, April 1997

Articles

The Importance of Hands for the Person Who is Deafblind
By Barbara Miles
www.nationaldb.org

Tactile Learning Strategies for Children who are Deaf-Blind: Concerns and Considerations from Project SALUTE
Deborah Chen, Ph.D.
June Downing, Ph.D.
Gloria Rodriguez-Gil, M.Ed.
California State University, Northridge
www.projectsalute.net

Hand Under Hand

Purpose:

  • To provide access to the experience of how people use their hands in relation to one another, including direction of movement, amount of force, speed or tempo (without engaging the student’s startle reflex or opposition to having hands picked up)
  • To provide spatial awareness of the distance between hands, for people who are blind or have low vision
  • To involve the student in routine tasks that they cannot yet perform independently
  • To stimulate curiosity, the desire to do things themselves, and to reduce passivity and dependence

Important Points:

  • Too much touch distracts the brain
  • Too much talking distracts the brain
  • Provide the student with daily “observation” time (with their hands as their “eyes” even if they have some vision)
    • Keep both of their hands engaged on yours throughout the task. Make it a brief task.
    • Start with something the student likes!
  • This is teaching active participation and learning
  • Students with “tactile defensiveness” accept this better than your hand over their hand because they are doing the touching with their palms/fingers rather than being touched on the sensitive back of their hand or wrist.

Directions:

Try positioning yourself behind or beside the student, depending on their body size and response, so that your arms and hands are positioned to operate as though they were the student’s hands and arms.

You may have to sit on a chair behind or beside them or squat to get your shoulder level down closest to their level. Young children can sit in your lap.

Position their hands on top of your fingers and hands. This can be accomplished by:

  • Tell them to do it,
  • Placing your hands under their hands and reach for the task, or
  • You may be able to lightly “clamp” their hands to yours with your thumbs in the initial stages of training them to observe with their hands.

If the child pulls his or her hands away or becomes upset with hand to hand contact, the student may need more sensory/motor awareness of their hands. Consider incorporating a hand lotion time (adult massages their hands) as part of their daily routines.

Adapted from material by: Geraldine G. Larrington, MA,OTR/L, Arizona Schools for the Deaf & Blind, April 1997